Document Detail


Comparison of standardized clinical classification with fundus photograph grading for the assessment of diabetic retinopathy and diabetic macular edema severity.
MedLine Citation:
PMID:  23615341     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To compare evaluation by clinical examination with image grading at a reading center for the classification of diabetic retinopathy and diabetic macular edema.
METHODS: Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Family Investigations of Nephropathy in Diabetes (FIND) had similar methods of clinical and fundus photograph evaluation. For analysis purposes, the photographic grading scales were condensed to correspond to the clinical scales, and agreement between clinicians and reading center classification were compared.
RESULTS: Six thousand nine hundred and two eyes of ACCORD participants and 3,638 eyes of FIND participants were analyzed for agreement (percent, kappa) on diabetic retinopathy on a 5-level scale. Exact agreement between clinicians and reading center on diabetic retinopathy severity category was 69% in ACCORD and 74% in FIND (kappa 0.42 and 0.65). Sensitivities of the clinical grading to identify the presence of mild nonproliferative retinopathy or worse were 0.53 in ACCORD and 0.84 in FIND. Specificities were 0.97 and 0.96, respectively. Diabetic macular edema agreement in 6,649 eyes of ACCORD participants and 3,366 eyes of FIND participants was similar (kappa 0.35 and 0.41). Sensitivities of the clinical grading to identify diabetic macular edema were 0.44 and 0.53 and specificities were 0.99 and 0.94, respectively.
CONCLUSION: The results support the use of clinical information for defining broad severity categories but not for documenting small-to-moderate changes in diabetic retinopathy over time.
Authors:
Sapna Gangaputra; James F Lovato; Larry Hubbard; Matthew D Davis; Barbara A Esser; Walter T Ambrosius; Emily Y Chew; Craig Greven; Letitia H Perdue; Wai T Wong; Audree Condren; Charles P Wilkinson; Elvira Agrón; Sharon Adler; Ronald P Danis;
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Retina (Philadelphia, Pa.)     Volume:  33     ISSN:  1539-2864     ISO Abbreviation:  Retina (Philadelphia, Pa.)     Publication Date:    2013 Jul-Aug
Date Detail:
Created Date:  2013-06-26     Completed Date:  2014-01-29     Revised Date:  2014-07-02    
Medline Journal Info:
Nlm Unique ID:  8309919     Medline TA:  Retina     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1393-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Diabetic Retinopathy / diagnosis*
Diagnostic Techniques, Ophthalmological / statistics & numerical data
Fundus Oculi
Humans
Macular Edema / diagnosis*
Observer Variation
Photography / methods*
Sensitivity and Specificity
Severity of Illness Index
Grant Support
ID/Acronym/Agency:
M01-RR00425/RR/NCRR NIH HHS; N01-HC-95178/HC/NHLBI NIH HHS; N01HC95178/HL/NHLBI NIH HHS; R01 DK069844/DK/NIDDK NIH HHS; R01-DK0069844/DK/NIDDK NIH HHS; UL1 TR000124/TR/NCATS NIH HHS
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